Cal. Code Regs. tit. 22 § 51533

Current through Register 2024 Notice Reg. No. 23, June 7, 2024

Section 51533 - Outpatient Heroin Detoxification Services

(a) Daily treatment of patients shall be reimbursed in accordance with the schedule shown below:

Procedure Code	Per Visit Allowance
Z6600	(1) Services rendered during the first seven days, per visit Services shall include: taking of the initial history; physical examination by a physician; other physician services necessary to the heroin detoxification services; necessary urine screening tests and related specimen handling; daily visits to the clinic for medication or reexamination; any other procedures related to outpatient heroin detoxification services...........................	..........................$14.60
Z6602	(2) Services rendered from the 8th through the 21st day, per visit Services shall include administering medication and other procedures related to outpatient heroin detoxification services...........................	..........................$9.29
Z6604	(3) Reexamination by a physician between 8th and 21st days, maximum of one per week, per visit Reexamination by a physician shall be provided only as a substitute for visits under (a) (2) and payment shall include all other services specified under (a) (2)...........................	..........................$18.01

(b) Additional charges may be billed by appropriately licensed facilities or by physicians or other Medi-Cal providers for services medically necessary to diagnose and treat diseases which, in the individual patient, the physician believes are concurrent with but not part of the outpatient heroin detoxification services as defined in Section 51116. Fees for additional physician services provided for the diagnosis and treatment of concurrent diseases or illness shall be reduced to reflect any fees already paid in the daily outpatient heroin detoxification service.

(c) A new course of outpatient heroin detoxification treatment shall not be covered until at least 28 days have elapsed since the completion of an immediately preceding course. New courses of outpatient heroin detoxification treatment by the same provider which are started in the period between the 29th and through the 90th days following the completion of an immediately preceding course of treatment shall be reimbursed at the rates listed under (a) (2) and (3). The daily rate listed under (a) (1) shall not be billed by the same provider or separately billed by a physician employee of that provider until 90 days have elapsed. The patient may be considered a new patient for reimbursement purposes after 90 days following the completion of the immediately preceding course of heroin detoxification.

(d) The patient may be considered a new patient for reimbursement purposes by a new provider for heroin detoxification services started in the period between the 29th through the 90th days following completion of an immediately preceding course of heroin detoxification services only if the fact of the preceding course is denied or misrepresented by the patient. Otherwise reimbursement shall be according to Section (c).

Cal. Code Regs. Tit. 22, § 51533

1. Amendment of subsection (a) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31.) A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 81, No. 52.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment of subsection (a) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
4. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
5. Amendment of subsection (a) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
7. Editorial correction of subsection (c) (Register 95, No. 45).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; and Statutes of 1985, Chapter 111, Items 4260-106-001 and 890.